Uniform crimping and deployment methods for polymer scaffold

ABSTRACT

A medical device-includes a scaffold crimped to a catheter having an expansion balloon. The scaffold is crimped to the balloon by a process that includes one or more balloon pressurization steps. The balloon pressurization steps are selected to enhance scaffold retention to the balloon and maintain a relatively uniform arrangement of balloon folds about the inner surface of the crimped scaffold so that the scaffold expands in a uniform manner when the balloon is inflated.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to drug-eluting medical devices; moreparticularly, this invention relates to processes for crimping apolymeric scaffold to a delivery balloon.

2. Background of the Invention

The art recognizes a variety of factors that affect a polymericscaffold's ability to retain its structural integrity when subjected toexternal loadings, such as crimping and balloon expansion forces.According to the art, characteristics differentiating a polymeric,bio-absorbable scaffolding of the type expanded to a deployed state byplastic deformation from a similarly functioning metal stent are manyand significant. Indeed, several of the accepted analytic or empiricalmethods/models used to predict the behavior of metallic stents tend tobe unreliable, if not inappropriate, as methods/models for reliably andconsistently predicting the highly non-linear behavior of a polymericload-bearing portion of a balloon-expandable scaffold (hereinafter“scaffold”). The models are not generally capable of providing anacceptable degree of certainty required for purposes of implanting thescaffold within a body, or predicting/anticipating the empirical data.

Polymer material considered for use as a polymeric scaffold, e.g.poly(L-lactide) (“PLLA”), poly(L-lactide-co-glycolide) (“PLGA”),poly(D-lactide-co-glycolide) or poly(L-lactide-co-D-lactide)(“PLLA-co-PDLA”) with less than 10% D-lactide, and PLLD/PDLA stereocomplex, may be described, through comparison with a metallic materialused to form a stent, in some of the following ways. A suitable polymerhas a low strength to weight ratio, which means more material is neededto provide an equivalent mechanical property to that of a metal.Therefore, struts must be made thicker and wider to have the requiredstrength for a stent to support lumen walls at a desired radius. Thescaffold made from such polymers also tends to be brittle or havelimited fracture toughness. The anisotropic and rate-dependant inelasticproperties (i.e., strength/stiffness of the material varies dependingupon the rate at which the material is deformed) inherent in thematerial, only compound this complexity in working with a polymer,particularly, bio-absorbable polymer such as PLLA or PLGA.

One challenge to a peripheral scaffold is crimping to a balloon andexpansion of the scaffold when the balloon is inflated. Problems arisewhere, on the one hand, the scaffold cannot be crimped to the desiredsize without introducing structural failure, i.e., fracture, orexcessive cracking, either in the crimped state or when expanded fromthe crimped state by a balloon. On the other hand, a scaffold can becrimped and deployed, yet deploys with non-uniformity in its deployedstate. In these cases the scaffold is susceptible to acute or fatiguefailure as the irregularly-deployed rings and/or cells, loaded beyondtheir design limits as a consequence of the non-uniform deployment, havea reduced acute or fatigue life within the vessel.

Additionally, the retention force keeping a crimped scaffold on adelivery balloon during transit through tortuous anatomy is sometimesnot sufficiently high to preclude pre-mature dislodgment of the scaffoldfrom the balloon. If the scaffold is not held on the balloon withsufficient force, e.g., as where there is recoil in the scaffoldfollowing crimping or the coefficient of friction between balloon andscaffold is too low, the scaffold can become separated from the balloonas the catheter distal end flexes and/or impinges on walls of thedelivery sheath. For a metallic stent, there are several well-knownapproaches for increasing the retention of the stent to a balloon duringtransit to the target site. However, methods proposed thus far forretaining the scaffold on a balloon are in need of improvement, orinappropriate for a polymer scaffold.

In one example of a method for crimping a metallic stent to a deliveryballoon, the stent is placed in a crimper and the temperature elevatedto facilitate greater compliance in the balloon material to allowmaterial to extend between gaps in the stent struts. Additionally,balloon pressure is maintained while the stent is being crimped toincrease stent retention to the balloon. After an initial pre-crimp, thestent is placed on the delivery balloon and allowed to slightly recoilunder balloon pressure and while the stent has an elevated temperature.After this step, the stent is crimped onto the balloon while the balloonis pressurized. The stent is cycled through larger and smallerdiameters. Additionally, balloon pressure may be supplied in bursts orheld constant during these crimping steps. Further details of thisprocess may be found in U.S. application Ser. No. 12/895,646 filed Sep.30, 2010 (docket no. 50623.1358).

The art previously devised methods for retaining a balloon-expandedpolymer scaffold on a delivery balloon. In one example, the scaffold iscrimped to the delivery balloon at a temperature well below thepolymer's TG. Then the scaffold, disposed between ends of the balloon,is thermally insulated from the balloon's ends. The ends of the balloonare then heated to about 185 degrees Fahrenheit to expand the diameterof the balloon material at its ends. The expanded balloon ends formraised edges abutting the scaffold ends to resist dislodgment of thescaffold from the balloon. In one example, this process provided aretention force of about 0.35 lb. for a Poly (L-lactide) (PLLA) scaffoldcrimped to a polymide-polyether block co-polymer (PEBAX) balloon. Anexample of this process is disclosed in U.S. Pat. No. 6,666,880.

Another example of a polymer scaffold crimping is found in U.S. Pat. No.8,046,897, which has a common inventor with the present application.According to the '897 patent the balloon is inflated, or partiallyinflated before crimping. The scaffold is placed on the balloon. Thecrimping may take place at elevated temperatures, e.g., 30-50 degreesCelsius.

A film-headed crimper has been used to crimp stents to balloons.Referring to FIG. 8A, there is shown a perspective view of a crimpingassembly 20 that includes three rolls 123, 124, 125 used to position aclean sheet of non-stick material between the crimping blades and thestent prior to crimping. For example, upper roll 125 holds the sheetsecured to a backing sheet. The sheet is drawn from the backing sheet bya rotating mechanism (not shown) within the crimper head 20. A secondsheet is dispensed from the mid roll 124. After crimping, the first andsecond (used) sheets are collected by the lower roll 123. As analternative to rollers dispensing a non-stick sheet, a stent may becovered in a thin, compliant protective sheath before crimping.

FIG. 8B illustrates the positioning the first sheet 125 a and secondsheet 124 a relative to the wedges 22 and a stent 100 within theaperture of the crimping assembly 20. As illustrated each of the twosheets are passed between two blades 22 on opposite sides of the stent100 and a tension T1 and T2 applied to gather up excess sheet materialas the iris of the crimping assembly is reduced in size via theconverging blades 22.

The dispensed sheets of non-stick material (or protective sheath) areused to avoid buildup of coating material on the crimper blades forstents coated with a therapeutic agent. The sheets 125 a, 124 a arereplaced by a new sheet after each crimping sequence. By advancing aclean sheet after each crimp, accumulation of contaminating coatingmaterial from previously crimped stents is avoided. By using replaceablesheets, stents having different drug coatings can be crimped using thesame crimping assembly without risk of contamination or buildup ofcoating material from prior stent crimping.

There is a continuing need to improve upon methods for crimping apolymer scaffold to a delivery balloon in order to improve upon theuniformity of deployment of a polymer scaffold from the balloon, toincrease the retention force between scaffold and balloon, and to obtaina minimal crossing profile for delivery of the scaffold to a targetsite.

SUMMARY OF THE INVENTION

The invention provides methods for increasing uniformity of polymerscaffold expansion via a balloon inflated delivery system, whilemaintaining or improving upon scaffold-balloon retention. A preferreduse for the invention is crimping a coronary scaffold to a deliveryballoon.

It has been demonstrated that the retention force of a crimped polymerscaffold on a delivery balloon may be increased by a crimping processthat includes crimping the scaffold to the balloon while the balloon ispressurized; that is, the balloon is pressurized at the same time as thescaffold's outer diameter is being reduced by crimper blades. Additionalfeatures of such a crimping process include heating the scaffold to atemperature close to the glass transition temperature (TG) of thepolymer material and applying balloon pressure during dwell periods(i.e., balloon pressure is applied when the scaffold diameter is heldconstant).

For a balloon-expanded polymer scaffold it was found that processes forcrimping the scaffold to the balloon, in order to ensure safe deliveryto an implant site, expansion and implantation of an intact scaffoldwere in need of modification. In particular, it was found that certainmodifications were needed to ensure that all three of the followingrequirements for a crimping process would be met:

-   -   Structural integrity: avoiding damage to the scaffold's        structural integrity when the scaffold is crimped to the        balloon, or expanded by the balloon.    -   Safe delivery to an implant site: avoiding dislodgement or        separation of the scaffold from the balloon during transit to an        implant site.    -   Uniformity of expansion: avoiding non-uniform expansion of        scaffold rings, which can lead to structural failure and/or        reduced fatigue life.

Regarding the uniformity of expansion requirement, it has been recentlyfound that earlier crimping processes, while satisfying the other tworequirements, have not consistently expanded in a uniform manner whenthe balloon is expanded. As a consequence, ring struts and/or cellstructures, which provide radial strength and stiffness for thescaffold, inherit an un-even distribution of stresses and strains.Over-expanded cells are called upon to sustain higher-than-normalstresses and strains while neighboring under-expanded cells areunderutilized. The balloon-induced stresses and strains associated withover-expanded cells can exceed the material's ultimate stress and strainlevel at deployment, which might potentially result in crack formationor fracture, or exhibit a reduced fatigue life or fracture toughness, inwhich case fracture can occur immediately, after a few days, or afterweeks of implantation.

In view of the foregoing objectives, the invention provides crimpingprocesses for improving upon the uniformity of expansion of a polymerscaffold crimped to a balloon including the step of inflating thedelivery balloon for substantially the entire crimp. For example, thedelivery balloon may be inflated when the scaffold is placed on theballoon and just prior to inserting the balloon and scaffold within acrimper head, then maintaining about this pressurization until after thescaffold diameter has been decreased to about 50% or more of itspre-crimp diameter.

In one embodiment, the balloon is pressurized until just prior to afinal crimping step. For example, the balloon is pressurized until afinal crimping step that reduces the scaffold diameter by an additionalabout 25%, or by an additional about 10%.

Balloon pressurization may be set at a constant value, e.g., between20-70 psi, or the balloon pressure may be set at a plurality of valuesduring crimping. For example, balloon pressure may be decreased afterthe scaffold has reached a certain crimping diameter, e.g., after thescaffold diameter has decreased by about 40-50%. In one example, thereare two programmed balloon pressure settings (high and low)corresponding to, respectively, a high and low diameter for the scaffoldduring the crimping process, e.g., about 150 psi and between about 20-70psi.

In another embodiment, a crimping process includes balloonpressurization while the scaffold to balloon diameter is sufficientlylarge to allow substantially all of the pre-arranged folds of theballoon to be removed. In this inflated state, the scaffold is thencrimped to the balloon until the scaffold diameter has been reduced insize to about 50% (or more).

According to another embodiment, a crimping process including balloonpressurization prior to and during crimping produces a crimped scaffoldand balloon whereby substantially all pre-arranged folds are removedwhen the scaffold-balloon are in a fully-crimped state (e.g., at thepoint in time when a restraining sheath is placed over the scaffold andballoon to limit recoil).

According to another embodiment, the crimping steps may include only 1,or only 3, or at most 3 dwell three dwell periods between an initialdiameter reduction and final diameter reduction.

According to another embodiment, a crimping process reduces a scaffolddiameter to only 30% to its pre-crimp size. According to this processthe scaffold diameter is reduced by an additional about 60-70% after aninitial crimp and there is no dwell period when the scaffold is reducedin diameter by the additional about 60-70%.

In a preferred embodiment the crimping process includes an alignmentcheck. The balloon inflated state is preferably maintained during thealignment check. In other embodiments one may dispense with thealignment check, so that the scaffold is removed from the crimper onlyafter it is fully crimped to the balloon.

INCORPORATION BY REFERENCE

All publications and patent applications mentioned in the presentspecification are herein incorporated by reference to the same extent asif each individual publication or patent application was specificallyand individually indicated to be incorporated by reference. To theextent there are any inconsistent usages of words and/or phrases betweenan incorporated publication or patent and the present specification,these words and/or phrases will have a meaning that is consistent withthe manner in which they are used in the present specification.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A is an example of a flow process for crimping a polymer scaffoldto a balloon.

FIG. 1B shows the crimping portion of the FIG. 1A flow process ingraphical form, plotting scaffold diameter vs. time and indicating theballoon pressure supplied during steps of the crimping process.

FIG. 2A shows an arrangement of balloon folds about a catheter shaft andnear a distal end of a balloon after completion of the crimping processof FIGS. 1A-1B (crimped scaffold not shown).

FIG. 2B shows an arrangement of balloon folds about a catheter shaft andnear the middle of the balloon after completion of the crimping processof FIGS. 1A-1B (crimped scaffold not shown).

FIG. 2C shows an arrangement of balloon folds about a catheter shaft andnear the proximal end of the balloon after completion of the crimpingprocess of FIGS. 1A-1B (crimped scaffold not shown).

FIG. 3 shows a portion of a scaffold after balloon expansion for ascaffold crimped to a balloon using the crimping process of FIGS. 1A-1B.

FIG. 4A is another example of a flow process for crimping a polymerscaffold to a balloon.

FIG. 4B shows the crimping portion of the FIG. 4A flow process ingraphical form, plotting scaffold diameter vs. time and indicating theballoon pressure supplied during steps of the crimping process.

FIG. 5A is another example of a flow process for crimping a polymerscaffold to a balloon.

FIG. 5B shows the crimping portion of the FIG. 5A flow process ingraphical form, plotting scaffold diameter vs. time and indicating theballoon pressure supplied during steps of the crimping process.

FIG. 6A shows an arrangement of balloon folds about a catheter shaft andnear a distal end of a balloon after completion of the crimping processof FIGS. 4A-4B (crimped scaffold not shown).

FIG. 6B shows an arrangement of balloon folds about a catheter shaft andnear the middle of the balloon after completion of the crimping processof FIGS. 4A-4B (crimped scaffold not shown).

FIG. 6C shows an arrangement of balloon folds about a catheter shaft andnear the proximal end of the balloon after completion of the crimpingprocess of FIGS. 4A-4B (crimped scaffold not shown).

FIG. 7 shows an example of a portion of a scaffold for crimping to aballoon according to the disclosure.

FIG. 8A is a perspective view of a prior art film-headed crimper.

FIG. 8B is a frontal view of the head of the film-headed crimper of FIG.8A as crimper jaws are being brought down on a stent.

FIGS. 9A-9C are photographs of the cross-section of a scaffold having apre-crimp pattern as shown in FIG. 7 when crimped to a balloon of aballoon catheter. FIG. 9A shows the cross-section shape of balloon foldsnear the distal end of the balloon. FIG. 9B shows the cross-sectionshape of balloon folds near the middle of the balloon. FIG. 9C shows thecross-section shape of balloon folds near the proximal end of theballoon. The crimped scaffold and balloon of FIGS. 9A-9C was obtainedusing the process of FIGS. 1A-1B.

FIG. 10 is a photograph showing a scaffold having a pattern similar tothat shown in FIG. 7 after balloon expansion. The scaffold shown in thispicture was expanded using the process of FIGS. 1A-1B. As shown in thisphotograph, the scaffold exhibits a non-uniform expansion and there arefractures in the rings of the scaffold.

FIGS. 11A-11C are photographs of the cross-section of a scaffold havinga pre-crimp pattern as shown in FIG. 7 when crimped to a balloon of aballoon catheter. FIG. 11A shows the cross-section shape of balloonfolds near the distal end of the balloon. FIG. 11B shows thecross-section shape of balloon folds near the middle of the balloon.FIG. 11C shows the cross-section shape of balloon folds near theproximal end of the balloon. The crimped scaffold and balloon of FIGS.11A-11C was obtained using the process of FIGS. 4A-4B.

FIG. 12 is a photograph showing a scaffold having a pattern similar tothat shown in FIG. 7 after balloon expansion. The scaffold shown in thispicture was expanded using the process of FIGS. 4A-4B. As shown in thisphotograph, the scaffold exhibits a more uniform expansion and there areno fractures in the rings of the scaffold.

FIG. 13A is a FINESCAN image of a scaffold having a pattern similar tothat shown in FIG. 7. The scaffold was crimped using the process ofFIGS. 1A-1B. The scaffold was then expanded by inflation of the balloon.As shown in this image, the scaffold exhibits a non-uniform expansion.

FIG. 13B is a FINESCAN image of a scaffold having a pattern similar tothat shown in FIG. 7. The scaffold was crimped using the process ofFIGS. 4A-4B. The scaffold was then expanded by inflation of the balloon.As shown in this image, the scaffold exhibits a more uniform expansionthan the scaffold in FIG. 13A.

DETAILED DESCRIPTION OF EMBODIMENTS

The “glass transition temperature,” TG, is the temperature at which theamorphous domains of a polymer generally change from a brittle, vitreousstate to a solid deformable or ductile state at atmospheric pressure. Inother words, the TG corresponds to the temperature where the onset ofnoticeable segmental motion in the chains of the polymer occurs. When anamorphous or semi-crystalline polymer is exposed to an increasingtemperature, the coefficient of expansion and the heat capacity of thepolymer both increase as the temperature is raised, indicating increasedmolecular motion. As the temperature is raised the actual molecularvolume in the sample remains constant, and so a higher coefficient ofexpansion points to an increase in free volume associated with thesystem and therefore increased freedom for the molecules to move. Theincreasing heat capacity corresponds to an increase in heat dissipationthrough movement. TG of a given polymer can be dependent on the heatingrate and can be influenced by the thermal history of the polymer.Furthermore, the chemical structure of the polymer heavily influencesthe glass transition by affecting mobility.

Poly(lactide-co-glycolide) (PLGA) and Poly (L-lactide) (PLLA) areexamples of a class of semi-crystalline polymers that may be used toform the scaffolds described herein. PLLA is a homopolymer and PLGA is aco-polymer. The percentage of glycolide (GA) in a scaffold constructedof PLGA may vary, which can influence the lower range of TG. Forexample, the percentage of GA in the matrix material may vary between0-15%. For PLLA, the onset of glass transition occurs at about 55degrees Celsius. With an increase of GA from about 0% to 15% the lowerrange for TG for PLGA can be correspondingly lower by about 5 degreesCelsius. For PLGA having % GA of about 5% the temperature ranges forcrimping may be between about 46 to 53 degrees Celsius. For PLGA having% GA of about 15% the temperature ranges for crimping are about 43 to 50degrees Celsius.

In one embodiment, a tube is formed by an extrusion of PLLA. The tubeforming process described in US Pub. No. 2010/00025894 may be used toform this tube. The finished, solidified polymeric tube of PLLA may thenbe deformed in radial and axial directions by a blow molding processwherein deformation occurs progressively at a predetermined longitudinalspeed along the longitudinal axis of the tube. For example, blow moldingcan be performed as described in U.S. Publication No. 2009/0001633. Thisbiaxial deformation, after the tube is formed, can produce noticeableimprovement in the mechanical properties of the scaffold structuralmembers cut from the tube without this expansion. The degree of radialexpansion that the polymer tube undergoes characterizes the degree ofinduced circumferential molecular or crystal orientation. In a preferredembodiment, the radial expansion ratio or RE ratio is about 450% of thestarting tube's inner diameter and the axial expansion ratio or AE ratiois about 150% of the starting tube's length. The ratios RA and AE aredefined in U.S. Pub. No. 2010/00025894.

A scaffold's outer diameter (made according to the foregoing processes)may be designated by where it is expected to be used, e.g., a specificlocation or area in the body. The outer diameter, however, is usuallyonly an approximation of what will be needed during the procedure. Forinstance, there may be extensive calcification that breaks down once atherapeutic agent takes effect, which can cause the scaffold to dislodgein the vessel. Further, since a vessel wall cannot be assumed ascircular in cross-section, and its actual size only an approximation, aphysician can choose to over-extend the scaffold to ensure it stays inplace. For this reason, it is sometimes preferred to use a tube with adiameter larger than the expected deployed diameter of the scaffold.

As discussed earlier, fabrication of a scaffold presents challenges thatare not present in metallic stents. One challenge, in particular, is thefabrication of a scaffold, which means the load bearing network ofstruts including connectors linking ring elements or members thatprovide the radial strength and stiffness needed to support a lumen. Inparticular, there exists an ongoing challenge in fabricating a scaffoldthat is capable of undergoing a significant degree of plasticdeformation without loss of strength, e.g., cracks or fracture ofstruts. In one embodiment the ratio of deployed to fully crimpeddiameter is about 2.5. In this embodiment, the crimped diametercorresponds to an outer diameter that is only about 40% of the startingdiameter. Hence, when deployed the drug eluting scaffold is expected toincrease in size at least to about 2.5 times its crimped diameter size.

In one particular example, a scaffold is formed from a bi-axiallyexpanded tube having an outer diameter of 3.5 mm, which approximatelycorresponds to a deployed diameter (the scaffold may be safely expandedup to 4.0 mm within a lumen). The iris of the crimping mechanism reachesa diameter of 0.044 in, which is maintained for a 185 sec dwell period(i.e., scaffold held at 0.044 in outer diameter within crimpingmechanism). When later removed from the crimper, the scaffold willrecoil despite there being a restraining sheath placed over the scaffoldimmediately after the scaffold is removed from the crimper. The scaffoldand sheath are then subjected to radiation sterilization. At the pointof use, i.e., at the point in time when a medical specialist removes therestraining sheath, the scaffold has an outer diameter of about 0.052 in(1.32 mm), or about 35-40% of the starting tube diameter of 3.5 mm. Whenin the crimping mechanism the scaffold reaches about 30-35% of thestarting tube size.

An additional challenge faced with the scaffold is the ability of thescaffold to be crimped to the balloon so that an adequate retentionforce is established between the scaffold and balloon. A “retentionforce” for a scaffold crimped to a balloon means the maximum forceapplied to the scaffold along the direction of travel through a vesselthat the scaffold-balloon is able to resist before dislodging thescaffold from the balloon. The retention force for a scaffold on aballoon is set by a crimping process, whereby the scaffold isplastically deformed onto the balloon surface to form a fit that resistsdislodgment of the scaffold from the balloon. Factors affecting theretention of a scaffold on a balloon are many. They include the extentof surface-to-surface contact between the balloon and scaffold, thecoefficient of friction of the balloon and scaffold surfaces, and thedegree of protrusion or extension of balloon material between struts ofthe scaffold. As such, the magnitude of a pull off or retention forcefor a scaffold generally varies with its length. The shorter scaffold,therefore, is more likely to dislodge from the balloon as the catheteris pushed through tortuous anatomy than a longer scaffold where the samecrimping process is used for both the longer and shorter scaffolds.

For a metal stent there are a wide variety of methods known forimproving the retention force of a stent on a balloon via modificationof one or more of the foregoing properties; however, many are notsuitable or of limited usefulness for a scaffold, due to differences inmechanical characteristics of a scaffold verses a metal stent, asdiscussed earlier. Most notable among these differences is brittlenessof polymer material suitable for balloon-expanded scaffold fabrication,verses that of a metal stent, and the sensitivity of the polymermaterial to heat. Whereas a metal stent may be deformed sufficiently toobtain a desired retention force, the range of deformation available toa polymer scaffold, while avoiding cracking or fracture-relatedproblems, by comparison, is quite limited. The application of heat hasbeen shown as effective for increasing retention forces for metalstents. However, the heat levels used can cause detrimental effects tothe polymer material since they tend to correspond to temperatures wellwithin, or above the TG of the material. For this reason, known heatmethods for increasing retention forces for metal stents tend to beviewed as inappropriate for increasing a retention force between ascaffold and balloon.

It has been more of a challenge to achieve high retention forces for acrimped polymer scaffold, as compared to a crimped metal stent, forbasically two reasons. First, there is less space available betweenstruts in a crimped state, which prevents balloon material fromextending between struts. As a result, there is less abutment orinterference between struts and balloon material, whichinterference/abutment has previously been relied upon to increase theretention force of a metal stent on a balloon. This condition is aresult of the need to fabricate wider and thicker struts for thescaffold, as compared to a metal stent, so as to provide adequate,deployed radial strength. Additionally, metal stents may be cut from atube closer to the crimp diameter whereas a polymer scaffold may be cutfrom a tube at about the fully expanded diameter, which further reducesthe space between struts in the crimped configuration. Second, a polymeris more sensitive to temperature ranges that have previously been usedto increase retention to a balloon. Heating of a scaffold to within, orabove TG induces significant changes in the molecular orientation of thepolymer material that result in loss of strength when the scaffold isplastically deformed to its deployed diameter.

U.S. patent application Ser. No. 12/772,116 filed Apr. 30, 2010(US20110270383) (docket no. 62571.399) ('116 application) discusses astudy that was conducted to investigate the effects on retention forcesfor crimped scaffolds. Principally, this study identified a temperaturerange relative to a TG of the scaffold material that improved retentionforces without detrimentally affecting scaffold mechanical propertieswhen deployed to support a vessel. For PLLA it was found that modifyingthe pressure and hold time of the scaffold for crimping temperatures ofbetween about 40° and 55° C. improved the scaffold retention, with about45-51° C. and about 48° C. being preferred temperatures for a PLLAscaffold. Additionally, the '116 application found that retention forcescould be improved if the scaffold were crimped down to an intermediatediameter and then the balloon is deflated then re-inflated, followed bycrimping the scaffold down to a final crimp diameter. The '116application also contemplates similar results for PLGA, if TG for thismaterial is taken into consideration and assuming other characteristicsof the process and scaffold pattern. For PLGA having % GA of about 5%the temperature ranges for crimping may be between about 46 to 53degrees Celsius. For PLGA having % GA of about 15% the temperatureranges for crimping are about 43 to 50 degrees Celsius.

When the scaffold is crimped to a balloon while being heated totemperatures well within the range of TG for the scaffold polymer, thereis a greater tendency for polymer chain re-alignment to occur that willresult in loss of strength when the scaffold is later deployed.Unacceptable crack formation (either in the number or extent of cracks),voids or outright fracture was observed in subsequent testing. If thecrimping temperature is raised too high relative to the TG of thepolymer, the memory of the matrix material at the starting tubingdiameter is being removed, or reformed as the scaffold is deformed. As aconsequence, when the scaffold is later expanded under physiologicalconditions, e.g., body temperature; it becomes more susceptible to crackformation due to its brittle properties at body temperatures and lack ofchain alignment from its starting diameter. Retention force and scaffoldintegrity when crimped to the balloon generally improves at highertemperatures, however, the scaffold loses its structural integrity whenlater deployed if the temperature is raised too high, e.g., above TG. Onthe other hand, when the scaffold is heated to temperatures below about15 degrees Celsius of the glass transition temperature, or not heated atall, there is no noticeable improvement in scaffold retention. It wasfound that the most effective range was between about 15 degrees belowand up to about TG.

The '116 application explains that the above and related unexpectedresults may be explained in the following manner. When a polymerscaffold is crimped at a temperature slightly below its TG (e.g., from 5to 15 degrees Celsius below TG), there are very short chains of thematrix material that are able to freely move to assist in thedeformation of the scaffold without exceeding material stress limits. Atthe same time, the longer chains of the matrix substantially maintaintheir alignment, and, thus, stay intact without losing their orientationset when the starting tube was expanded. By doing so, the scaffold maybe crimped down to a diameter for good scaffold retention, while theorientation of a majority of polymer chains would be the same to ensuredesirable strength and fracture toughness in the final product, i.e.,when the scaffold is deployed to support a vessel.

FIG. 1 of the '116 application shows a flow for a crimping process for a3.0 mm (0.118 in) scaffold that is crimped to a final crimp diameter of0.044 in. The diameter reduction from 0.118 in to 0.044 in includesthree intermediate crimping diameters of 0.083 in, 0.063 in and 0.07 in,following a “pre-crimp” procedure in which the PLLA scaffold temperatureis raised to a temperature of about 48° C. When the scaffold hasattained the intermediate crimp diameters, the crimper jaws are held atthe crimping diameter for a dwell period of 30 sec, 15 sec and 10 sec,respectively. After the final crimp diameter has been obtained, thecrimp jaws are held at the final crimp diameter for about 200 sec. Thedelivery balloon, i.e., a PEBAX balloon, is inflated to a pressure of 17psi for the dwell period 30, 15 and 10 second dwell periods. The dwellperiods for the intermediate crimping stages are included in the processto allow for stress relaxation in the polymer material before decreasingthe scaffold diameter further. Before the crimper iris is reduced byactuation of the crimper jaws, the balloon is deflated. Thus, in theexample from the '116 application whenever the scaffold diameter isdecreased, the balloon is not inflated.

Notwithstanding improved results in stent retention when practicinginventions described in the '116 application, it is desirable to furtherincrease a scaffold retention force. For example, for a coronaryscaffold it is desirable to have a balloon-scaffold retention force(i.e., force required to pull scaffold off balloon) of at least 0.7 lbsand preferably over 1.0 lbs.

Processes are proposed for achieving a high retention force whilemaintaining the structural integrity of a crimped polymer scaffold. Onesuch process is described in co-pending application Ser. No. 13/089,225(docket no. 65271.517) (the '225 application) having a common assigneeas this application. According to this disclosure, methods are proposedthat increase the retention force on an 18 mm length, 3.5 mm pre-crimpdiameter scaffold by at least 0.5 lbs over the process used to producethe data in the '116 application.

FIGS. 1A-1B describe a flow process and graph, respectively, of acrimping method for a 3.5 mm diameter and 18 mm length scaffold (FIGS.1A-1B are taken from the '225 application). The method is described interms of a series of five “stages” with diameter reduction steps betweenstages. Each “stage” refers to a period where the crimper jaws aremaintained at a constant diameter for a dwell period. The scaffolddiameter is held constant during these periods. The boxes 20 and 10 inthe graph is identifying times when the iris diameter is being reduced(same convention used for FIGS. 4B and 5B, supra).

For the stages preceding the “final alignment” or “verify finalalignment” step in FIGS. 1A-1B, where the scaffold and balloon areremoved from the crimper to check alignment, the balloon is inflated tominimize further out of plane, or irregular movement or twisting ofstruts initiated in preceding crimping steps during subsequent crimpingsteps. Some of the advantages of inflating a balloon during these dwellperiods to achieve this result are explained in U.S. application Ser.No. 12/861,719 filed Aug. 23, 2010 (US20120042501) (docket no.62571.448) (the '719 application).

As mentioned earlier, a polymer scaffold, and in particular a misalignedpolymer scaffold is more susceptible to damage within a crimper than acorresponding metal stent. A polymer scaffold that has even a “slight”misalignment within the crimper has a far greater chance of becomingdamaged than a metal stent. Of course, the need to avoid twisting orbending in struts of metal stents when in a crimper is known. However,unlike metal stents, which are far more tolerant of local irregular ornon-uniform forces acting on struts through blade edges, polymer strutsare more easily distorted when the crimping forces are non-uniformlyapplied. Due to the proximity of struts to each other (as required sincethicker and wider struts are needed to provide equivalent stiffness to ametal stent and there is sometimes a greater diameter reduction neededduring crimping), there is a greater chance of abutting struts whichleads to out of plane twisting and overlapping scaffold structure in thecrimped state. The effects of irregular or non-uniform crimping forceson a polymer scaffold are therefore more severe than in the case of ametal stent. The differences are most clearly evident in the instancesof cracking and/or fracture in deployed polymer scaffolds that showirregular twisting or bending.

More local support for individual struts during the dwell periods isbelieved to correct for struts predisposed to twist or overlap withadjacent struts (a strut predisposed to twist or overlap with otherstruts refers to a strut that was previously slightly bent or twistedout of plane when the scaffold was at a larger diameter). In essence,balloon pressure during the dwell periods is believed to apply abeneficial correcting force on the luminal side of struts, which canserve to limit a strut's potential to overlap or twist further ascrimper blades are applied in subsequent steps.

When crimped down from a larger diameter (e.g., from 0.136 to 0.11 in inFIG. 1A), there is little stabilizing support available for the scaffoldsince its diameter is much larger than the deflated balloon upon whichthe scaffold sits. As such, any initial non-uniform applied crimpingforce, or misalignment, e.g., due to a residual static charge on thepolymer surface, can initiate irregular bending that becomes morepronounced when the scaffold diameter is reduced further. Frictionbetween the blades and the scaffold surface, or residual static chargeor static charge buildup induced by sliding polymer surfaces are alsosuspect causes of this irregular deformation of the scaffold. When theballoon is inflated to support the scaffold from the interior duringdwell periods, the irregular bending and twisting of struts seen at thefinal crimp diameter (when the scaffold is removed from the crimper)were reduced substantially. The scaffold was more able to maintain aproper orientation with respective to the crimper axis.

Referring again to FIGS. 1A-1B, the scaffold is partially crimped, thenremoved from the crimper to check its alignment on the balloon (StagesI, II, III as the dwell periods). The scaffold is then returned to thecrimper to perform final crimp steps, e.g., Stage IV, reduce to 0.044in, then dwell Stage V. During these final steps the balloon isapproximately at a constant pressure. Unlike earlier crimping steps, theballoon is pressurized when the scaffold is crimped to the finaldiameter. The presence of balloon pressure during the final crimp (the“intermediate pressure” step), as compared to the same process withoutthe “intermediate pressure” step, i.e., about atmospheric balloonpressure for the final crimp, greatly increased the retention force ofthe scaffold to the balloon. Stated differently, the retention force ofscaffold to balloon was much higher when the balloon is pressurizedduring the final crimp, or diameter reduction step.

It is believed that the greatly increased retention force was achievedbecause the balloon material opposing gaps in scaffold struts during thefinal crimp tended to extend in-between gaps more often as the scaffoldwas crimped due to the opposing balloon pressure applied to the balloonmaterial. Without this pressure, the balloon material tended to deflectaway from the gaps as the size of the gaps narrowed during the finalcrimp. Essentially, the balloon pressure forced more balloon materialinto gaps—rather than deflect the material away from the gaps—when thediameter is being reduced in size.

It should be noted that there was concern over whether the “intermediatepressure” step would cause balloon damage for balloon pressure appliedin an amount that would make a difference in scaffold retention. Thegaps between scaffold struts for a scaffold having significant diameterreductions and relatively thick struts are narrower than for struts of ametal stent. Forcing balloon material into narrower spaces gave rise toconcerns that balloon material would be excessively pinched betweenstruts, thereby causing damage to the balloon. In one example thepressure applied during the earlier dwell periods (Stages I, II and III)is about twice that applied during the final crimp steps (150 psi and 70psi, respectively), as shown in FIGS. 1A-1B. This ratio of balloonpressure (i.e. about 150:70 for corresponding diameters of about 0.1 inand about 0.07 in, about 3.5 mm pre-crimp diameter and about 0.044 infinal crimp diameter, FIGS. 1A-1B) was found to produce good results,despite the previous concerns. It is contemplated that other pressureratios, or increased pressure values may improve results. It was found,however, that a relatively modest amount of pressure applied during theintermediate pressure step can produce significant improvement inscaffold retention, so that the risk of damaging a balloon and/orscaffold is reduced.

According to the '225 application, balloon pressure may be applied inbursts, rather than set at a constant level, during the intermediatepressure step. Further, there may be benefits to using balloon pressureduring the prior partial crimp steps. Since the scaffold is re-alignedfollowing the earlier crimp steps, the benefits of using balloonpressure during earlier crimping steps are not so much believed to layin increased retention. Rather, balloon pressure may help avoidirregular twisting or bending in scaffold struts (for the reasonsdiscussed above) as the scaffold diameter is being reduced.

Example 1

Further details of the FIG. 1A flow process for a 3.5 mm scaffoldmanufacture and crimping to a delivery balloon will now be discussed.FIG. 1B illustrates in graphical form the crimping portion of the FIG.1A flow—a graph of scaffold diameter verses time with a balloon pressureof 150 psi or 70 psi applied during the dwell periods and theintermediate pressure step (i.e., crimping between Stage IV and StageV). The scaffold was crimped using a crimper having film-sheets disposedbetween the metal crimper blades and the scaffold. This particular typeof crimper was discussed earlier in connection with FIGS. 8A-8B.

As discussed above, the scaffold is formed from a PLLA or PLGAprecursor, including a biaxial expansion of the precursor to form atube, followed by laser cutting the scaffold from the tube. Next, apre-crimp procedure is performed, which includes placing the scaffoldbetween the balloon markers and aligning the scaffold with the iris ofthe crimper. Using an anti-static air gun, both the scaffold andinterior of the iris chamber are deionized. The deionization step wasfound necessary to reduce misalignments of the scaffold resulting from astatic charge buildup caused by sliding contact between polymersurfaces, as explained in more detail in U.S. application Ser. No.12/776,317 filed May 7, 2010 (62571.398).

Stage I:

The scaffold (supported on the balloon of the balloon-catheter) isplaced within the crimp head. The crimping temperature is obtained byheating the crimper jaws to an appropriate temperature and then bringingthe jaws into thermal contact with the scaffold. The crimper jaws areset to 0.136 in and maintained in this position for about 10 seconds toallow the scaffold temperature to increase to a crimping temperaturethat is near to, but below the TG of the scaffold material (e.g., thecrimping temperature for a PLLA scaffold of FIG. 1 is 48+/−3° C.). Moregenerally, the scaffold temperature may be between 5 and 15 degreesCelsius below TG for the polymer material. Whenever the scaffold iswithin the crimper head its temperature is at, or rose to the crimpingtemperature (e.g., 48+/−3° C.) for the crimping process described inFIGS. 1A-1B.

After the scaffold reaches the crimping temperature, the iris of thecrimper closes to reduce the scaffold diameter from 0.136 in (3.5 mm) toabout 0.11 in, or about a 20% diameter reduction. During this diameterreduction step (Stage I->Stage II) the balloon pressure is maintained atabout atmospheric temperature. The about 20% reduction in diameteroccurs over a period of about 5.2 seconds. As compared to subsequentdiameter reduction steps, this diameter reduction is performed moreslowly because strut angles are at their widest. It was found that aslow rate of diameter reduction can significantly improve yield, interms of more uniformity of compression in the scaffold structure; thatis, to enable the scaffold structure to compress more evenly, withoutirregular bending or twisting of strut and/or link structure. Furtherdetails on this aspect of the crimping process are described in the '719application.

Stage II:

The crimper jaws are held at the 0.11 in diameter, the balloon isinflated to a pressure of 150 psi, and the scaffold and balloon aremaintained in this configuration for a 30 second dwell period at thecrimping temperature. As explained earlier, the balloon is inflated to150 psi to help with stabilizing the scaffold structure and correctingfor any misalignment, or twisting of struts that might have occurredwhen the iris diameter was being reduced in size.

After the 30 second dwell period is complete, the balloon pressure isreturned to about atmospheric pressure and the crimper iris is movedfrom 0.11 in to 0.068 in or about a 38% diameter reduction. During thissecond diameter reduction or crimp step (Stage II->Stage III) theballoon pressure is maintained at about ambient temperature. This about38% reduction in diameter occurs over a period of 1.0 second. The about50% diameter reduction was found to achieve an acceptable balancebetween balloon-scaffold engagements while retaining an ability tore-align the scaffold in a Final Alignment step). If the scaffold iscrimped too tightly before Final Alignment, then it becomes difficult tore-position it between balloon markers. If crimped too loosely beforeFinal Alignment, then the scaffold can shift again after FinalAlignment. It will be appreciated that this balance also should takeinto consideration the available spacing between struts for balloonmaterial.

Stage III:

The crimper jaws are held at the 0.068 in diameter, the balloon is againinflated to a pressure of 150 psi, and the scaffold and balloonmaintained in this configuration for a 15 second dwell period at thecrimping temperature to correct or counter any twisting or misalignmentthat might have developed when the scaffold diameter was reduced byabout an additional 38%.

Final Alignment Step:

After the 15 second dwell period is complete, the scaffold and balloonare removed from the crimper to check the scaffold alignment on theballoon. This alignment involves a visual inspection and if necessarymanual adjustment of the scaffold to place it between the balloonmarkers. Alternatively, alignment may be performed by an automatedprocess, as explained in U.S. application Ser. No. 12/831,878 filed Jul.7, 2010 (docket no. 62571.425).

As mentioned earlier, the scaffold's starting or pre-crimp diameter isabout equal to, or greater than the deployed diameter for the scaffold,which is between about 2.5 and 3.0 times its final crimped diameter. Theexpanded tube and pre-crimp scaffold diameter is 2.93 times thefinal-crimp size in the illustrated example. This difference indiameters between scaffold and balloon, coupled with the likelihood thatcrimper jaws will not apply a net-zero longitudinal force on thescaffold as the diameter is reduced, and/or that the scaffold will beslightly misaligned when it reaches the balloon surfaces, has lead to aneed for re-aligning, or verifying alignment of the scaffold on theballoon; that is, checking to see that the scaffold is located betweenballoon markers.

The additional, time-consuming alignment step that interrupts thecrimping process is typically not required for a metal stent, for tworeasons. First, the starting diameter for a metal stent is much closerto the final diameter, which means the balloon-stent interaction thatholds the stent in place happens relatively quickly. Second, for highercrimping rates used for metal stents, there is usually less ability forthe stent to shift longitudinally over the balloon surface. Metal stentscan be crimped at relatively high rates, whereas crimp rates for polymerscaffolds generally should be monitored and often times reduced (frommetal crimp rates) because a polymer scaffold's structural integrity inits crimped and deployed states is affected by the crimp rate. Whilemetals exhibit rate independent material behavior, polymers areviscoelastic and exhibit rate dependent material response. Polymerssubjected to higher strain or displacement rates will tend to experiencehigher stresses and exhibit less ductility.

After Stage III the scaffold's diameter has been reduced to about ½ ofits starting diameter. In some cases not until a scaffold diameter isreduced to about 50% of its pre-crimp diameter size is thescaffold-balloon interaction sufficient to prevent longitudinal shiftingof the scaffold on the balloon when the scaffold is crimped downfurther. In the example of FIG. 1A the final-alignment step is performedonce the scaffold reaches about 50% of its pre-crimp diameter.

Stage IV:

The scaffold and balloon are placed into the crimper. The jaws areclosed to a diameter of 0.07 in and the balloon inflated to a pressureof 70 psi (the pressure used for the intermediate pressure step in thisexample). Thereafter the scaffold is crimped to its final crimp diameterof 0.044 in or about a 33% reduction in diameter over a period of about2.6 seconds while balloon pressure is maintained at 70 psi. Before thefinal diameter reduction to 0.044 in commences, a dwell period of 10seconds at the 70 psi balloon pressure is performed to allow time forthe scaffold to return to the crimping temperature.

As illustrated in FIG. 1B, at the start of the Stage IV step the balloonpressure is set to 70 psi, and this setting is unchanged during thesubsequent Stage IV dwell, the subsequent diameter reduction from 0.07in to 0.044 in or about a 33% reduction (“intermediate pressure”), andthe Stage V dwell. The pressure is not adjusted to maintain 70 psi; assuch the balloon pressure is expected to change somewhat from 70 psiduring the intermediate pressure step.

Stage V:

After the scaffold has been reduced in diameter from 0.07 in to 0.044 inthe balloon pressure is maintained at 70 psi for a period of about 15seconds.

Following Stage V dwell period, the balloon pressure is returned toabout atmospheric pressure and the crimper jaws are held at the finalcrimp diameter for a 185 second dwell period. During this final dwellperiod the degree of recoil in the scaffold is reduced. Immediatelyfollowing the 185 second dwell the scaffold is removed and a retainingsheath is placed over the scaffold to reduce recoil.

Trials were conducted and reported in the '225 application (reproducedbelow) to estimate the likely pull-off or retention force for a 3.5mm×18 mm PLLA scaffold crimped to a 0.044 in final crimp diameter andcrimped to a PEBAX balloon. The TABLE below shows results from thesetrials. The mean of the retention force for the scaffold for 9 trialsusing the process of FIGS. 1A-1B was significantly higher than the meanof the retention force for the “control case”—i.e., the same process asin FIGS. 1A-1B but without balloon pressure when the diameter wasreduced from 0.07 in to 0.044 in the final crimping stages. Thescaffolds used during these trials had substantially the same pattern asshown in FIG. 7. Statistics are shown below for five Test cases.

Mean Standard Crimping retention deviation process force (lb) (lb) FIG.1A process Test case 1 1.32 0.33 Test case 2 1.63 0.11 Test case 3 1.430.16 Test case 4 1.56 0.17 Test case 5 1.55 0.12 FIG. 1A process withoutballoon Control: 0.70 0.10 pressure when diameter reduced from .07 to.044.

The results above were unexpected, since it was previously not believedthat a pressurization of the balloon during the final crimp by about ½the pressure of prior dwell periods would make much of a difference inthe retention force. The results demonstrate an about 30% to about 88%improvement in retention force over the “control” case.

Example 2

The process described in FIGS. 1A-1B had been adopted in a modified formfor use in crimping a scaffold intended for use in a peripheral artery,e.g., a scaffold described in co-pending application Ser. No. 13/015,474(docket no. 104584.10). When applied to this peripheral scaffold,however, it was found that the scaffold exhibited non-uniform expansioncharacteristics. In order to address this problem, a modified crimpingprocess was devised. Such a process is described in co-pendingapplication Ser. No. 13/194,162 (docket no. 104584.19) ('162application), which has a common assignee to the present application.The process proposed is summarized in TABLE 1.

TABLE 1 Crimping process described in the ′162 application Outer CrimpBalloon Balloon Crimp Diameter head Dwell pressuri- pressurizationControl setting Speed times zation dwell times settings (in.) (in/sec)(sec) (50 psi) (sec) Initial point 0.640 Step 1 0.354 0.300 0 Ambient 0Step 2 0.270 0.005 30 Ambient 0 Step 3 0.210 0.005 30 Ambient 0 Step 40.160 0.005 30 Ambient 0 Step 5 0.130 0.005 30 Ambient 0 Step 6 0.1400.050 30 Ambient 0 Step 7 0.130 0.005 30 Ambient 0 Step 8 0.100 0.005 30Pressure 30 Step 9 0.062 0.005 30 Ambient 170

As compared to the process depicted in FIGS. 1A-1B (as modified for usewith a peripheral scaffold), balloon pressure is applied only during thefinal crimping step. Prior to this step the balloon was not pressurized.By not pressurizing the balloon during steps 5 and 7, it was found thatthe balloon retained, more or less, its original balloon folds, ascompared to the asymmetric or non-uniform arrangement of balloon foldspresent about the balloon's circumference when the balloon was alsopressurized during dwell periods (steps 5 and 7) as explained below inconnection with FIGS. 2A-2C. According to the '162 application, whenballoon pressure is applied according to the TABLE 1 process, asubstantial improvement in uniformity of expansion can be achieved for aballoon-expanded scaffold.

While the uniform-expansion results reported in the '162 application areencouraging, it should be noted that, unlike a coronary scaffold,processes for crimping a peripheral scaffold generally produce adequatestent retention forces without additional measures being needed in orderto assure that the scaffold will remain on the balloon when the scaffoldis advanced through tortuous vessels. The same cannot be said for acoronary scaffold.

A peripheral scaffold is typically much longer than a coronary scaffold(retention force is proportional to the length of a scaffold). Thus,while a relatively low retention force per unit length may be acceptablefor a peripheral scaffold, the same retention force per unit length maynot be acceptable for a coronary scaffold. There is, therefore, a needfor a crimping process for a coronary scaffold that both increases theretention force per unit length and results in more uniform expansion ofthe coronary scaffold.

Returning again to FIGS. 1A-1B, this process when applied to a coronaryscaffold having a length of 18 mm (typical size for a coronary scaffold)increased the retention force over prior methods of crimping, as notedearlier. Also discussed earlier, the balloon is inflated only after thescaffold is partially crimped, and balloon pressure is applied onlyduring dwell times and during a final crimp step (i.e., the“intermediate pressure step”).

In a preferred embodiment the balloon is inflated, or at least partiallyinflated before the scaffold diameter is reduced within the crimper.Additionally, balloon pressure is maintained for substantially theentire crimp process, as opposed to only during a portion of thecrimping time, as was the case of the FIGS. 1A-1B examples. The balloonpressure may be maintained at more or less a constant value as in theexamples (below) or varied depending on the crimped state of thescaffold. For example, the balloon inflation may begin at 150 psi thenbe reduced as the scaffold is crimped down, e.g., reduced from 150 psito 70 psi, or from 150 to between 20-70 psi, or from 70 to 20 psi afterthe crimper iris has reached a pre-designated diameter. In otherembodiments, the ratio of balloon pressure when the iris has a firstdiameter, e.g., pre-crimp diameter, to a second diameter, e.g., justprior to the final crimp, may be about 7:1 or about 2:1 for acorresponding about 3:1 to 2:1 iris diameter (e.g., the balloon pressureis about 7/2 times greater for an iris diameter prior to crimping (StageI) then the balloon pressure for the iris diameter just prior to thefinal crimp).

Continuously maintaining an inflated, or partially inflated balloon, orgradually reducing the inflation pressure during most of the crimpingprocess is presently preferred based on a finding that an inflatedballoon promotes a more uniform expansion of the scaffold from itscrimped to deployed configuration. It is further believed that bymaintaining balloon pressure during the crimping process one can evenproduce a higher retention force. These discoveries and/or insights arebased on inspection of expanded scaffolds and balloon cross-sections forscaffolds crimped using the FIGS. 1A-1B process.

FIGS. 2A, 2B, and 2C are drawings intending to depict observedarrangements, or distributions of balloon folds when a scaffold is fullycrimped using the process of FIGS. 1A-1B. Shown in FIGS. 2A, 2B, and 2Cis a catheter shaft 4 and the balloon 8 (the crimped scaffold is notalso drawn so that the balloon shapes can be more easily shown indrawings). FIG. 2A shows the arrangement of balloon folds about thecircumference of the catheter shaft nearer the distal end of theballoon. FIG. 2B shows the arrangement of balloon folds about thecircumference of the catheter shaft nearer the middle of the balloon.And FIG. 2C shows the arrangement of balloon folds about thecircumference of the catheter shaft nearer the proximal end of theballoon (photographs of the cross-section of a scaffold crimped to aballoon, taken from the distal, middle and proximal portions of theballoon are provided in FIGS. 9A-9C).

As shown in each of these three drawings or photographs, about half ofthe circumference of the catheter shaft 4 is traversed by only a single,unfolded layer of balloon material. The remaining half of the shaftcircumference has several balloon folds bunched together. When pressureis applied to a balloon having folds arranged in this manner and engagedwith a crimped stent, the resulting balloon expansion will impart higherexpansion forces on the scaffold struts abutting the balloon foldsbunched within region A′ than the struts abutting the balloon materialextending over section B′. The result is a non-uniform expanded scaffoldpattern, as depicted in FIG. 3 (FIG. 13A is a FINESCAN image of anexpanded scaffold after crimping using the FIGS. 1A-1B process). FIG. 10shows an expanded scaffold. This scaffold was crimped using the processof FIGS. 1A-1B then expanded by the balloon. The scaffold shows anon-uniform expansion of rings and there are fractured struts.

When comparing FIG. 3 to FIG. 7 (idealized scaffold pattern afterexpansion), the effects of a non-uniform arrangement of balloon foldsbecomes apparent. The shapes of the cell regions, e.g., 236′ and 236″,are irregular. These irregular-shaped cells indicate that some ringshave been expanded beyond their design angles while others have not beenexpanded to their design angles. The over-extended angles can lead tocrack propagation at the crown and in some cases, failure of rings at ornear the crown. While the net result is the intended expanded diameter,e.g., about 3.5 mm, the distribution of stresses among the ring strutsis uneven and affects the structural integrity of the expanded scaffold.

Examples of preferred embodiments for a crimping process are nowprovided. Two examples are provided. For each example, several of thesame processes described earlier for FIGS. 1A-1B also apply, exceptwhere noted. Therefore, unless stated otherwise, the same descriptionabove for FIGS. 1A-1B also applies to these examples.

Example 3

FIGS. 4A-4B illustrate the steps associated with a first example of acrimping process according to the preferred embodiments. FIG. 4Billustrates in graphical form the crimping portion of the FIG. 4A flow—agraph of scaffold diameter verses time with a balloon pressure ofbetween about 20-70 psi applied throughout substantially all of thecrimping process. For example, the balloon pressure is maintained atbetween 20-70 psi until the completion of a Stage IV of a preferredcrimping process.

Stage I:

The scaffold supported on the inflated balloon of the balloon-catheteris placed within the crimp head. The balloon when inflated andsupporting the scaffold in this state preferably has substantially allfolds removed.

After the scaffold reaches the crimping temperature, the iris of thecrimper closes to reduce the scaffold inner diameter (ID) is slightlyless than the outer diameter (OD) of the pressurized balloon (e.g., from0.136 in (3.5 mm) to about 0.12 in, or about a 15% diameter reduction).

Stage II:

The crimper jaws are held at the 0.12 in diameter and maintained at thisdiameter for a second dwell period at the crimping temperature.

Final Alignment Step:

After the second dwell period is complete, the scaffold and balloon areremoved from the crimper to check the scaffold alignment on the balloon.

After Stage II the scaffold's diameter has been reduced to about 80-85%of its starting diameter. It was observed that when the scaffolddiameter is reduced to about 80-85% of its pre-crimp diameter size thescaffold-balloon interaction is sufficient to prevent longitudinalshifting of the scaffold on the pressurized balloon when the scaffoldwas crimped down further. In the example of FIGS. 4A-4B, therefore, thefinal-alignment step is performed once the scaffold reaches about 80-85%of its pre-crimp diameter for the balloon, which is preferably inflatedto less than its fully inflated configuration, e.g., 20-70 psi. Theballoon inflation pressure for crimping according to the disclosure maybe expressed as a percentage of the nominal inflation pressure for theballoon, e.g., 7 atmospheres (atm) for a 3.0 mm balloon. Thus, for theinflation pressure 20-70 psi in the examples and a 7 atm nominalinflation pressure the crimping balloon pressure would correspond toabout 20% to about 80% of the nominal inflation pressure for theballoon. And for the balloon having an 18 atm upper or over-inflatedpressure (about 3.5 mm for a 3.0 mm nominally inflated balloon) thecrimping balloon pressure would correspond to about 10% to about 30% ofthe upper or over-inflated balloon pressure.

Stage III:

The scaffold and balloon are returned to the crimper. The jaws areclosed to a diameter the same as or similar to what is set in stage II,which may be slightly less than the scaffold OD when it is removed fromthe crimper (to check alignment) and recoils slightly. The crimper jawsare held at this diameter for a third dwell time, which may be the timeneeded for the scaffold to return to the crimping temperature.

The iris diameter is then reduced to an ID corresponding to about the ODfor the balloon if the balloon were not pressurized and had randomlydistributed folds. That is, the scaffold is crimped down to theapproximate OD for the balloon if it were pressurized then deflated sothat substantially all pre-made folds are replaced by random folds. Forexample, the iris diameter is reduced down to about 0.06 in for the 3.5mm scaffold where about 0.06 in corresponds approximately to the OD ofthe balloon at atmospheric pressure after the balloon is inflated andthen deflated so that substantially all folds are removed. After thisdiameter reduction the scaffold OD is about 50% of its diameter at StageIII and about 40% of its starting, or pre-crimp OD.

Stage IV:

After the scaffold OD is reduced to about 40% of its starting diameter,the crimper jaws are held at this diameter for a third dwell time.

Following the Stage IV dwell period, the balloon is deflated or allowedto return to atmospheric pressure and the iris of the crimper is reduceddown to a final crimp OD, e.g., 0.044 in or about 30% of its pre-crimpOD. This balloon deflation may occur by opening the valve supplying thepressurized gas to the balloon while, or just before the iris diameteris reduced to the final crimp diameter.

The crimper jaws are then held at the final crimp diameter for about a165 second dwell period. This final dwell period is intended to reducethe amount of scaffold recoil when the crimped scaffold is removed fromthe crimper. Immediately following the 165 second dwell the scaffold isremoved and a retaining sheath is placed over the scaffold to furtheraid in reducing recoil. A leak test may be done after the final stagecrimping.

The foregoing example of a preferred crimping process, which pressurizesthe balloon through most of the crimping steps (e.g., up until the finalcrimp step) is expected to provide two benefits. The first benefit isincreased scaffold-balloon retention. By maintaining pressure in theballoon through most of the crimping steps, more balloon material shouldbecome disposed between struts of the scaffold since balloon material isbeing pressed more into the scaffold, especially when the spaces betweenstruts are at their largest, e.g., the diameter reduction between StagesI and II, than the case when crimping is done without balloonpressurization, or only after the scaffold is reduced in diameter.Additionally, it is expected that by substantially removing folds beforeany diameter reduction, the balloon material becomes more compliant. Assuch, more balloon material is able extend between struts, rather thanbeing pressed between the scaffold and catheter shaft when the scaffoldis being crimped.

The second benefit of balloon pressurization is more uniform expansionof the crimped scaffold when the balloon is expanded. When the balloonis inflated from the beginning, before any crimping takes place and whenthere is the greatest space available for the balloon to unfold withinthe mounted scaffold, balloon material become more uniformly disposedabout the circumference of the catheter shaft after crimping. If theballoon is only partially expanded, as in the case where the balloon isinflated after the scaffold has been partially crimped (thereby leavingless space available for the balloon to fully unfold), it is believedthat the presence of folds or partial folds causes balloon material toshift or displace during crimping, thereby resulting in a morenon-uniform distribution of balloon material about the circumference ofthe catheter shaft after crimping. This type of behavior is depicted inFIGS. 2A-2C.

FIGS. 6A, 6B, and 6C are drawings intending to depict observedarrangements, or distributions of balloon folds when a scaffold is fullycrimped (scaffold not shown) using the preferred process of FIGS. 4A-4B((photographs of the cross-section of a scaffold crimped to a balloon,taken from the distal, middle and proximal portions of the balloon areprovided in FIGS. 11A-11C). FIG. 6A shows the arrangement of balloonfolds about the circumference of the catheter shaft nearer the distalend of the balloon. FIG. 6B shows the arrangement of balloon folds aboutthe circumference of the catheter shaft nearer the middle of theballoon. And FIG. 6C shows the arrangement of balloon folds about thecircumference of the catheter shaft nearer the proximal end of theballoon. As compared to the corresponding FIGS. 2A, 2B and 2C discussedearlier, FIGS. 6A-6C shown balloon material more evenly distributedabout the circumference of the catheter shaft. It was found that whenballoon material is arranged in a manner similar to that shown in FIGS.6A-6C, there was less non-uniformity in the expanded scaffold and lessinstances of cracks or fractures in scaffold struts caused by overexpansion.

FIG. 13B shows a FINESCAN image of a scaffold expanded after beingcrimped using the process of FIGS. 4A-4B. FIG. 12 shows a perspectiveview of scaffold expanded after crimping using this process. As can beappreciated by comparing these photographs to FIGS. 13A and 10,respectively, when crimped using the FIGS. 4A-4B process the scaffoldexpands more uniformly than when the scaffold is crimped using theprocess of FIGS. 1A-1B.

Example 4

FIGS. 5A-5B illustrate the steps associated with another example of acrimping process according to the preferred embodiments. FIG. 5Billustrates in graphical form the crimping portion of the FIG. 5A flow—agraph of scaffold diameter verses time. As with the previous example, aballoon pressure of between about 20-70 psi is applied throughoutsubstantially all of the crimping process. In this case, balloonpressure is maintained until the scaffold diameter has reached about 35%of its pre-crimp diameter. Additionally, in this example, following thefinal alignment check the iris diameter is continuously reduced at aslow rate until reaching the final crimping diameter.

Stage I:

The scaffold supported on the inflated balloon of the balloon-catheteris placed within the crimp head. The balloon when inflated andsupporting the scaffold in this manner preferably has substantially allfolds removed.

After the scaffold reaches the crimping temperature, the iris of thecrimper closes to reduce the scaffold inner diameter (ID) is slightlyless than the outer diameter (OD) of the pressurized balloon (e.g., from0.136 in (3.5 mm) to about 0.12 in, or about a 15% diameter reduction).

Stage II:

The crimper jaws are held at the 0.12 in diameter and maintained at thisdiameter for a second dwell period at the crimping temperature.

Final Alignment Step:

After the second dwell period is complete, the scaffold and balloon areremoved from the crimper to check the scaffold alignment on the balloon.

After Stage II, the scaffold's diameter has been reduced to about 80-85%of its starting diameter (as in the prior example).

The scaffold and balloon are returned to the crimper. The jaws areclosed to a diameter of about 0.12 in, which may be slightly less thanthe scaffold OD when it is removed from the crimper (to check alignment)and recoils slightly. The iris diameter is then reduced slowly from 0.12in to about 0.05 in (e.g., 0.07 in over a period of about 100-120seconds) to allow the visco-elastic material to deform without cracking.The diameter reduction during this step is about 40%. This diameterreduction following the alignment check may alternatively correspond toabout the diameter of the scaffold when the scaffold is removed from therestraining sheath at the point of use.

When the about 0.05 iris diameter is reached, the balloon pressure isrelieved while the iris diameter continues to slowly decrease until itreaches a 0.044 in diameter. When reaching the 0.044 diameter thescaffold is removed from the crimper and a retaining sheath is placedover the scaffold to reduce recoil.

In a similar manner to the previous example, by inflating the balloonbefore any crimping and maintaining balloon pressure until the irisdiameter reaches about 0.05 in it is believed that this preferredcrimping process will increase scaffold-balloon retention forces andresult in more uniform expansion of the scaffold.

Preferred Scaffold Pattern

As noted above, in a preferred embodiment a scaffold has the patterndescribed in U.S. application Ser. No. 12/447,758 (US 2010/0004735) toYang & Jow, et al. Other examples of scaffold patterns suitable for PLLAare found in US 2008/0275537. FIG. 7 shows a detailed view of anintermediate portion 216 of a strut pattern 200 depicted in US2010/0004735. The intermediate portion includes rings 212 with linearring struts 230 and curved hinge elements 232. The ring struts 230 areconnected to each other by hinge elements 232. The hinge elements 232are adapted to flex, which allows the rings 212 to move from anon-deformed configuration to a deformed configuration. Line B-B lies ona reference plane perpendicular to the central axis 224 depicted in US2010/0004735. When the rings 212 are in the non-deformed configuration,each ring strut 230 is oriented at a non-zero angle X relative to thereference plane. The non-zero angle X is between 20 degrees and 30degrees, and more narrowly at or about 25 degrees. Also, the ring struts230 are oriented at an interior angle Y relative to each other prior tocrimping. The interior angle Y is between 120 degrees and 130 degrees,and more narrowly at or about 125 degrees. In combination with otherfactors such as radial expansion, having the interior angle be at least120 degrees results in high hoop strength when the scaffold is deployed.Having the interior angle be less than 180 degrees allows the scaffoldto be crimped while minimizing damage to the scaffold struts duringcrimping, and may also allow for expansion of the scaffold to a deployeddiameter that is greater than its initial diameter prior to crimping.Link struts 234 connect the rings 212. The link struts 234 are orientedparallel or substantially parallel to a bore axis of the scaffold. Thering struts 230, hinge elements 232, and link struts 234 define aplurality of W-shape closed cells 236. The boundary or perimeter of oneW-shape closed cell 236 is darkened in FIG. 2 for clarity. In FIG. 7,the W-shapes appear rotated 90 degrees counterclockwise. Each of theW-shape closed cells 236 is immediately surrounded by six other W-shapeclosed cells 236, meaning that the perimeter of each W-shape closed cell236 merges with a portion of the perimeter of six other W-shape closedcells 236. Each W-shape closed cell 236 abuts or touches six otherW-shape closed cells 236.

Referring to FIG. 7, the perimeter of each W-shape closed cell 236includes eight of the ring struts 230, two of the link struts 234, andten of the hinge elements 232. Four of the eight ring struts form aproximal side of the cell perimeter and the other four ring struts forma distal side of the cell perimeter. The opposing ring struts on theproximal and distal sides are parallel or substantially parallel to eachother. Within each of the hinge elements 232 there is an intersectionpoint 238 toward which the ring struts 230 and link struts 234 converge.There is an intersection point 238 adjacent each end of the ring struts230 and link struts 234. Distances 240 between the intersection pointsadjacent the ends of rings struts 230 are the same or substantially thesame for each ring strut 230 in the intermediate portion 216 of thestrut pattern 200. The distances 242 are the same or substantially thesame for each link strut 234 in the intermediate portion 216. The ringstruts 230 have widths 237 that are uniform in dimension along theindividual lengthwise axis 213 of the ring strut. The ring strut widths234 are between 0.15 mm and 0.18 mm, and more narrowly at or about 0.165mm. The link struts 234 have widths 239 that are also uniform indimension along the individual lengthwise axis 213 of the link strut.The link strut widths 239 are between 0.11 mm and 0.14 mm, and morenarrowly at or about 0.127 mm. The ring struts 230 and link struts 234have the same or substantially the same thickness in the radialdirection, which is between 0.10 mm and 0.18 mm, and more narrowly at orabout 0.152 mm.

As shown in FIG. 7, the interior space of each W-shape closed cell 236has an axial dimension 244 parallel to line A-A and a circumferentialdimension 246 parallel to line B-B. The axial dimension 244 is constantor substantially constant with respect to circumferential positionwithin each W-shape closed cell 236 of the intermediate portion 216.That is, axial dimensions 244A adjacent the top and bottom ends of thecells 236 are the same or substantially the same as axial dimensions244B further away from the ends. The axial and circumferentialdimensions 244, 246 are the same among the W-shape closed cells 236 inthe intermediate portion 216.

It will be appreciated from FIG. 7 that the strut pattern for a scaffoldthat comprises linear ring struts 230 and linear link struts 234 formedfrom a radially expanded and axially extended polymer tube. The ringstruts 230 define a plurality of rings 212 capable of moving from anon-deformed configuration to a deformed configuration. Each ring has acenter point, and at least two of the center points define the scaffoldcentral axis. The link struts 234 are oriented parallel or substantiallyparallel to the scaffold central axis. The link struts 234 connect therings 212 together. The link struts 232 and the ring struts 230 definingW-shape closed cells 236. Each W-shaped cell 236 abuts other W-shapedcells. The ring struts 230 and hinge elements 232 on each ring 212define a series of crests and troughs that alternate with each other.Each crest on each ring 212 is connected by one of the link struts 234to another crest on an immediately adjacent ring, thereby forming anoffset “brick” arrangement of the W-shaped cells.

The above description of illustrated embodiments of the invention,including what is described in the Abstract, is not intended to beexhaustive or to limit the invention to the precise forms disclosed.While specific embodiments of, and examples for, the invention aredescribed herein for illustrative purposes, various modifications arepossible within the scope of the invention, as those skilled in therelevant art will recognize.

These modifications can be made to the invention in light of the abovedetailed description. The terms used in the claims should not beconstrued to limit the invention to the specific embodiments disclosedin the specification. Rather, the scope of the invention is to bedetermined entirely by the claims, which are to be construed inaccordance with established doctrines of claim interpretation.

1-17. (canceled)
 18. A method, comprising: using a scaffold having anouter diameter and made from a tube comprising a polymer having a glasstransition temperature (TG); using a balloon having pre-arranged folds;and crimping the scaffold to the balloon, including the steps of:inflating the balloon, and while the scaffold has a crimping temperatureof between TG and 15 degrees below TG crimping the scaffold to theinflated balloon, wherein the crimping includes a first dwell periodafter the diameter is reduced from a starting size to a first size, andwherein the scaffold diameter is reduced by an additional 60%-70% afterthe first dwell period.
 19. The method of claim 18, wherein there is nodwell period during the additional 60%-70% diameter reduction.
 20. Themethod of claim 18, wherein after the additional 60%-70% diameterreduction none of the pre-arranged folds are present in the balloon. 21.The method of claim 18, wherein the crimping includes only one dwellperiod.
 22. The method of claim 1, wherein the balloon is inflated toabout 20-80% of a nominal balloon inflation pressure, or about 10-30% ofan over-inflated or maximum inflation pressure for the balloon.
 23. Amethod, comprising: using a scaffold having a pre-crimp diameter andmade from a tube comprising a polymer having a glass transitiontemperature (TG); using a balloon having a nominal inflation diameterthat is less than the pre-crimp diameter; and crimping the scaffold tothe balloon while the scaffold has a crimping temperature of between TGand 15 degrees below TG, including the steps of: (a) inflating theballoon, (b) reducing the scaffold diameter from the pre-crimp diameterto a first diameter that is less than the nominal inflation diameter,and (c) after step (b) reducing the scaffold diameter by an additional60%-70% and there is no dwell period when the scaffold diameter isreduced by the additional 60%-70%.
 24. The method of claim 23, whereinthere is only one dwell period during crimping.
 25. The method of claim23, wherein the balloon has pre-arranged folds prior to inflation, andwhen the balloon is inflated substantially all folds are removed fromthe balloon.
 26. The method of claim 23, further including using acrimper device to reduce the scaffold diameter from the pre-crimpdiameter to the first diameter, wherein the scaffold is removed from thecrimper device after the scaffold diameter is reduced to the firstdiameter, followed by returning the scaffold to the crimping device andcrimping the scaffold to a second diameter that is less than the firstdiameter.
 27. The method of claim 23, further including placing thescaffold within a sheath, wherein the scaffold diameter size is 35%-40%of the pre-crimp diameter when inside the sheath.
 28. The method ofclaim 23, wherein the polymer comprises Poly (L-lactide) orPoly(lactide-co-glycolide).
 29. The method of claim 23, wherein thepolymer comprises Poly(lactide-co-glycolide) (PLGA), the temperaturerange is about 43 to 54 degrees centigrade and the glycolide content ofPLGA is between about 15% to 0%.
 30. A method, comprising: using ascaffold having a pre-crimp diameter and made from a tube comprising apolymer having a glass transition temperature (TG); using a balloonhaving a nominal inflation diameter that is less than the pre-crimpdiameter; and crimping the scaffold to the balloon, including the stepsof: heating the scaffold to an elevated temperature that is below TG,inflating the balloon to a crimping pressure that is 20% to 80% of anominal inflation pressure for the balloon, and reducing the scaffolddiameter from the pre-crimp diameter to a first diameter that is lessthan the nominal inflation diameter.
 31. The method of claim 30, whereinthe scaffold is heated to a temperature of between TG and 15 Deg. Cbelow TG.
 32. The method of claim 30, wherein the pre-crimp diameter isgreater than the nominal inflation diameter.
 33. The method of claim 30,further including reducing the scaffold diameter to a second diameterthat is less than the first diameter.
 34. The method of claim 30,wherein the balloon has pre-arranged folds prior to inflation, and whenthe balloon is inflated substantially all folds are removed from theballoon.
 35. The method of claim 30, further including using a crimperdevice to reduce the scaffold diameter from the pre-crimp diameter tothe first diameter, wherein the scaffold is removed from the crimperdevice after the scaffold diameter is reduced to the first diameter,followed by returning the scaffold to the crimping device and crimpingthe scaffold to a second diameter that is less than the first diameter.36. The method of claim 30, further including using a crimper device toreduce the scaffold diameter from the pre-crimp diameter to the firstdiameter and placing the scaffold in a sheath, wherein the scaffolddiameter size is 35-40% of the pre-crimp diameter when inside thesheath.
 37. The method of claim 30, wherein the polymer comprises Poly(L-lactide) or Poly(lactide-co-glycolide).